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12. Name and address of the licensed Massage Therapy Establishment that you expect to be <br />employed by. <br />CO 3/11- JYlr..s6a1e <br />13. Address(es) at which you have lived during preceding ten years. (Begin with present or last <br />address, and work back.) I <br />:29'3 /Y . 7M 4'0-a -eel gG�a q) oG t'v/ (NM 9 & -1O(4 <br />4 <br />11 <br />14. Kind, name, and location of every business or occupation you have been engaged in during <br />the preceding ten years. (Begin with present business and work back.) <br />Business or Street Address <br />Occupation City and State <br />Nature of Business <br />Or Occupation <br />2/0 l <br />15. Attach a certified copy of a diploma or certificate of graduation from a school of massage <br />therapy including a minimum of 600 hours in successfully completed course work as required <br />by City Code. <br />16. Have you ever been convicted of any felony, crime, or violation of any ordinance other than <br />traffic? <br />Yes ___72c_ No <br />If yes, given information as to the time, place, and offense for which convictions were had. <br />17. Have you been in military service? Yes x No <br />If yes, was discharge(s) ever other than honorable? <br />Yes No <br />(Upon request, you may be required to exhibit all discharges.) <br />9 <br />15 <br />